Organization
EMBRENCHE LLC
Active
Other names
embrenche
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTY HICKMAN (DIRECTOR)
(336) 722-8055
Entity
Organization
Contact information
Practice address
2070 CLOVERDALE DR, SUITES A&B, WINSTON SALEM, NC 27103-2624
(336) 722-8055
(336) 553-0665
Mailing address
2070 CLOVERDALE DR, SUITES A&B, WINSTON SALEM, NC 27103-2624
(336) 722-8055
(336) 553-0665
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300216G
—
NC
Enumeration date
03/07/2007
Last updated
12/19/2007
Update your record
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